Question 1

What is The Thyroidologist?

Accepted Answer

The Thyroidologist is a dedicated thyroid care practice based in Kathmandu, Nepal. We focus exclusively on thyroid disorders — diagnosis, treatment and long-term management.

Question 2

Do I need a referral to book an appointment?

Accepted Answer

No referral is required. You can book directly through our appointment form, by phone, WhatsApp or email.

Question 3

Do you offer teleconsultation?

Accepted Answer

Teleconsultation may be available for suitable follow-up and initial assessment. Contact us to discuss whether it fits your situation.

Question 4

What should I bring to my first appointment?

Accepted Answer

Any previous thyroid blood tests, ultrasound reports, medication lists, and a note of your symptoms and their duration.

Question 5

How much does a consultation cost?

Accepted Answer

Consultation fees vary by service type and duration. Contact us for current pricing and appointment availability.

Question 6

Do you see patients outside Kathmandu?

Accepted Answer

Yes — we serve patients across Nepal and welcome international patients. For those outside Kathmandu, we coordinate testing locally and offer teleconsultation where appropriate.

Question 7

Is hypothyroidism permanent?

Accepted Answer

In most cases, yes — primary hypothyroidism usually requires lifelong levothyroxine. Some cases caused by temporary thyroiditis or medication effects may resolve, but this is decided by your doctor through repeat testing.

Question 8

Can hypothyroidism be cured with diet or supplements?

Accepted Answer

No. Hypothyroidism is a hormone deficiency that cannot be corrected by diet alone. Iodine only helps in iodine-deficiency-related cases. Levothyroxine is the established, evidence-based treatment; any supplements should be discussed with your clinician first.

Question 9

How often should TSH be checked?

Accepted Answer

After starting or changing levothyroxine, TSH is usually rechecked every 6–8 weeks until stable, then roughly every 6–12 months. Your doctor will advise a schedule based on your situation.

Question 10

What happens if hypothyroidism is left untreated?

Accepted Answer

Untreated hypothyroidism can worsen symptoms and, over time, contribute to high cholesterol, heart problems, fertility issues and, rarely, a serious condition called myxoedema coma. Prompt diagnosis and treatment prevent these complications.

Question 11

Is hyperthyroidism serious?

Accepted Answer

Yes, if untreated it can cause atrial fibrillation, osteoporosis, heart failure and thyroid storm — a rare but life-threatening emergency. Early diagnosis and treatment are important.

Question 12

Which treatment is best — medication, RAI or surgery?

Accepted Answer

There is no single best option. Antithyroid drugs suit patients wanting to avoid permanent effects; RAI is convenient and effective for most; surgery is preferred for large goitres, compressive symptoms or suspected cancer. The choice is individualised.

Question 13

Will I become hypothyroid after treatment?

Accepted Answer

Quite possibly. RAI and surgery frequently lead to an underactive thyroid, which is managed with levothyroxine — a well-understood and easily treated condition.

Question 14

Can hyperthyroidism affect pregnancy?

Accepted Answer

Yes. Uncontrolled hyperthyroidism in pregnancy raises risks for both mother and baby, and Graves’ disease can affect the newborn. Thyroid function should be checked and managed carefully before and during pregnancy.

Question 15

Can Hashimoto’s be reversed?

Accepted Answer

The autoimmune process itself cannot currently be reversed, but the resulting hypothyroidism is fully treatable with levothyroxine. Most patients on adequate replacement live normal, healthy lives.

Question 16

Does a goitre mean I have Hashimoto’s?

Accepted Answer

Not necessarily. A goitre has many causes — iodine deficiency, nodules, Graves’ disease, thyroiditis. Ultrasound and antibody testing help clarify the cause.

Question 17

Should family members be tested?

Accepted Answer

If you have Hashimoto’s, first-degree relatives have a somewhat higher risk of thyroid autoimmunity. Discuss screening with your doctor, especially if they have symptoms.

Question 18

Can Graves’ disease go into remission?

Accepted Answer

Yes — roughly half of patients treated with antithyroid drugs for 12–18 months achieve lasting remission. Relapse is possible, so monitoring continues after stopping medication.

Question 19

Does radioactive iodine worsen eye disease?

Accepted Answer

RAI can potentially aggravate active Graves’ orbitopathy in susceptible patients. If significant eye disease is present, surgery or antithyroid drugs may be preferred; smoking cessation strongly reduces risk.

Question 20

Is Graves’ disease hereditary?

Accepted Answer

There is a genetic predisposition — it clusters in families — but most people with a relative affected do not develop it. Environmental triggers such as stress, smoking and iodine intake may contribute.

Question 21

Is thyroiditis contagious?

Accepted Answer

No. Although some forms follow viral infections, the thyroid inflammation itself is not contagious.

Question 22

Will my thyroid recover after thyroiditis?

Accepted Answer

Many forms resolve completely. Postpartum thyroiditis leaves about 20% of women permanently hypothyroid, so follow-up testing for at least 12 months is recommended.

Question 23

Why did my doctor not prescribe antithyroid medication?

Accepted Answer

In destructive thyroiditis the gland is leaking stored hormone rather than producing excess. Antithyroid drugs block production and therefore do not help; symptom control and monitoring are the correct approach.

Question 24

Do all thyroid nodules need a biopsy?

Accepted Answer

No. FNAC is recommended only for nodules meeting specific size and ultrasound-risk criteria. Most small, benign-appearing nodules are followed with ultrasound surveillance.

Question 25

Can nodules turn into cancer later?

Accepted Answer

Benign nodules rarely transform into cancer. The main risk is missing a cancer at initial evaluation, which is why ultrasound risk stratification and appropriate FNAC matter.

Question 26

Should I worry if I can feel a lump?

Accepted Answer

Many palpable nodules are benign, but any new neck lump should be evaluated — ultrasound is a simple, non-invasive first step.

Question 27

Is a goitre always a sign of thyroid disease?

Accepted Answer

Not always — a mild diffuse enlargement can occur without dysfunction. However, all goitres warrant evaluation to exclude hypothyroidism, hyperthyroidism, nodules or cancer.

Question 28

Can a goitre shrink on its own?

Accepted Answer

Sometimes. Small goitres related to thyroiditis or transient causes may regress. Iodine-deficiency goitres improve with iodine correction; autoimmune goitres may slowly change over time.

Question 29

When does a goitre need surgery?

Accepted Answer

Surgery is considered for compressive symptoms (trouble breathing or swallowing), suspicion of cancer, failure of medical therapy for toxic goitre, or significant cosmetic concern — decided case by case.

Question 30

Is thyroid cancer deadly?

Accepted Answer

Most thyroid cancers — particularly papillary and follicular — are highly treatable with excellent long-term survival. Anaplastic thyroid cancer is rare but serious and requires urgent specialist care.

Question 31

Will I need lifelong medication after thyroid cancer surgery?

Accepted Answer

After total thyroidectomy, most patients need lifelong levothyroxine. For differentiated cancers, the dose is often deliberately kept slightly higher initially (TSH-suppressive) as part of cancer follow-up.

Question 32

Can thyroid cancer spread?

Accepted Answer

Papillary cancer can spread to neck lymph nodes, and rarely to lungs or bone — but this is still often treatable. Medullary cancer has a higher metastatic potential and needs specialised surveillance.

Question 33

Is papillary thyroid cancer curable?

Accepted Answer

Yes, for the majority of patients it is effectively cured with surgery, with or without radioactive iodine. Long-term surveillance continues because late recurrence, while uncommon, is possible.

Question 34

Do I need total thyroidectomy?

Accepted Answer

Not always. For small, low-risk tumours confined to one lobe, lobectomy may be sufficient. Your surgeon weighs tumour size, lymph nodes, variant and patient factors.

Question 35

Why is my TSH kept low after surgery?

Accepted Answer

Suppressing TSH reduces stimulation of any residual thyroid tissue — a standard part of differentiated thyroid cancer follow-up. It requires monitoring to avoid side effects of over-replacement.

Question 36

Why couldn’t my biopsy confirm cancer?

Accepted Answer

Follicular lesions are cytologically indistinguishable — cells look identical whether the tumour is benign or malignant. The distinction is made by examining the surgical specimen for capsular or vascular invasion.

Question 37

Does follicular cancer spread to bones or lungs?

Accepted Answer

Widely invasive FTC can metastasise, most often to lung and bone. These metastases often still take up iodine and can be treated with radioactive iodine.

Question 38

Is FTC hereditary?

Accepted Answer

Sporadic FTC is not typically inherited. Rare familial syndromes exist, and your doctor may suggest genetic counselling if there is a strong family history.

Question 39

Is medullary thyroid cancer hereditary?

Accepted Answer

Yes, about 25% of cases are hereditary, caused by RET gene mutations — sometimes isolated, sometimes part of MEN2 syndrome. Genetic testing guides treatment and screening of relatives.

Question 40

Why doesn’t radioactive iodine work for MTC?

Accepted Answer

Radioactive iodine works only on follicular cells that express the sodium-iodide symporter. Medullary cancer arises from C cells, which lack this mechanism.

Question 41

What is the follow-up after MTC surgery?

Accepted Answer

Calcitonin and CEA levels are monitored lifelong — a rising calcitonin is the earliest sign of recurrence. Neck ultrasound and imaging follow as indicated.

Question 42

How quickly does anaplastic cancer grow?

Accepted Answer

It is typically fast-growing — a neck mass may enlarge noticeably over weeks. Rapid evaluation of any fast-growing neck lump in older adults is important.

Question 43

Is anaplastic thyroid cancer treatable?

Accepted Answer

It is difficult to treat but not untreatable. Aggressive multimodal therapy and clinical trials offer the best chance; outcomes depend heavily on stage at diagnosis.

Question 44

Is ATC related to other thyroid cancers?

Accepted Answer

It can arise de novo or through dedifferentiation of a pre-existing papillary or follicular cancer, which is why long-standing nodules warrant monitoring.

Question 45

Will subclinical hypothyroidism progress to overt disease?

Accepted Answer

Some cases progress over years, particularly with positive anti-TPO antibodies. Regular monitoring detects progression early.

Question 46

Do I need levothyroxine for mild TSH elevation?

Accepted Answer

Not always. The decision depends on TSH level, symptoms, age, antibodies and pregnancy plans — discuss with your doctor rather than self-treating.

Question 47

Can subclinical hypothyroidism cause symptoms?

Accepted Answer

Some patients report fatigue, weight gain or low mood, but these are non-specific. There is debate about whether mild TSH elevation itself causes symptoms; correlation does not prove causation.

Question 48

Is subclinical hyperthyroidism dangerous?

Accepted Answer

It is usually mild, but persistent cases — especially in older adults — carry increased cardiac and bone risks, so evaluation of cause and duration is important.

Question 49

Can it resolve without treatment?

Accepted Answer

Yes — transient causes (thyroiditis recovery, certain drugs) resolve on their own. Repeat testing distinguishes these from persistent disease.

Question 50

Should I stop my thyroid medication?

Accepted Answer

Never adjust thyroid medication without medical advice. Suppressed TSH can result from over-replacement, and your doctor may need to adjust your dose.

Question 51

Can postpartum thyroiditis affect my baby?

Accepted Answer

Thyroid hormones pass to breast milk in tiny amounts and levothyroxine is compatible with breastfeeding. Untreated severe thyroid dysfunction can affect mood and wellbeing — discuss symptoms with your doctor.

Question 52

Will it happen again in a future pregnancy?

Accepted Answer

Recurrence risk is significant — studies suggest roughly half of women have postpartum thyroiditis again in subsequent pregnancies. Pre-pregnancy thyroid function testing is wise.

Question 53

Is it the same as Hashimoto’s?

Accepted Answer

Postpartum thyroiditis is an inflammatory condition, often autoimmune in mechanism, but distinct from chronic Hashimoto’s. Many women with postpartum thyroiditis have positive anti-TPO antibodies.

Question 54

Will my child outgrow congenital hypothyroidism?

Accepted Answer

Most children need lifelong levothyroxine, though dose requirements change with growth. A few may be re-evaluated for recovery during childhood, but permanent treatment is the norm.

Question 55

Is congenital hypothyroidism inherited?

Accepted Answer

Most cases are sporadic developmental anomalies, not inherited. Some dyshormonogenesis forms are genetic — genetic counselling may be offered if there is a family history.

Question 56

What if screening was missed?

Accepted Answer

If a newborn shows signs of hypothyroidism — prolonged jaundice, poor feeding, large tongue, umbilical hernia — testing should be done immediately regardless of screening status.

Question 57

Is TMNG cancerous?

Accepted Answer

The autonomous nodules are almost always benign. However, any dominant nodule should be evaluated with ultrasound and FNAC if it meets suspicious criteria.

Question 58

Why is RAI often preferred over surgery?

Accepted Answer

RAI treats the entire gland without surgery and is effective for toxic nodular disease in older patients. Surgery is preferred for very large goitres, compressive symptoms, or patient preference.

Question 59

Will I become hypothyroid?

Accepted Answer

Yes — both RAI and total thyroidectomy for TMNG lead to hypothyroidism, managed with lifelong levothyroxine. This is expected and well-controlled.

Question 60

Do thyroid cysts need to be removed?

Accepted Answer

Most do not. Simple cysts are monitored; only recurrent, symptomatic or suspicious cysts are considered for aspiration or surgery.

Question 61

Can a cyst be cancer?

Accepted Answer

A purely fluid-filled cyst is almost never cancerous. Complex cysts with solid components require evaluation of the solid part — which is where cancer, if present, would be found.

Question 62

Why did my cyst suddenly hurt?

Accepted Answer

Cysts can bleed internally, causing rapid painful enlargement. This usually settles, but should be checked with ultrasound to confirm nothing else is going on.

Question 63

Can thyroid eye disease happen without Graves’?

Accepted Answer

Rarely — most cases are associated with Graves’ disease, but it can occur with other thyroid conditions or in isolation. Thyroid function testing is still important.

Question 64

Does treating the thyroid fix the eyes?

Accepted Answer

Treating thyroid dysfunction is necessary but not always sufficient — eye disease has its own course and may need specific treatment. Achieving and maintaining normal thyroid function helps overall management.

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